Breast Cancer in Pregnancy Is Rare but Found Treatable

Action Points

Explain to interested patients that this study provides additional evidence that breast cancer can be safely and effectively imaged and treated during pregnancy.

HOUSTON, March 29 - For breast cancer diagnosed during pregnancy, ultrasound provides an accurate alternative to mammography, according to investigators here.

So found Wei Tse Yang, M.D., and colleagues of the University of Texas M.D. Anderson Cancer Center in a retrospective review of radiology data on 23 women, median age 34, diagnosed and treated for breast cancer at their institution from 1989 to 2003. Small as it was, the study was the largest of its kind.

Reporting in the April issue of Radiology, the investigators recommended ultrasound as the initial imaging approach if there are breast cancer symptoms. But they did not rule out mammography and, in fact, found that the two modalities can have complementary roles.

Mammography, the investigators said, "may demonstrate malignant calcifications not imaged at ultrasound, and thus we believe mammography should be performed on pregnant women with a diagnosis of invasive or in situ malignancy."

Breast cancer is estimated to affect one in 3,000 to one in 10,000 pregnancies, the study noted.

The investigators underscored that breast cancer can be safely imaged and treated during pregnancy and that therapy should not be postponed until after pregnancy.

"Although local and systemic treatment strategies for a pregnant patient with breast cancer are similar to those for a non-pregnant patient, some modifications may be necessary in pregnant patients to minimize fetal harm," they wrote. "For example, breast irradiation, chest wall irradiation, or both are postponed until after delivery because of risks of fetal exposure to radiation."

They noted that because pregnant breast cancer patients have more locally advanced breast cancer at diagnosis than do non-pregnant patients, neoadjuvant chemotherapy may be appropriate during pregnancy.

All patients were treated with anthracycline-based chemotherapy during the second or third trimester. Of the 20 women for whom cancer could be staged, one had stage IV disease with metastases to the liver, 12 had stage III disease, six were stage II, and one was stage I.

Seventeen tumors were diagnosed with a combination of ultrasound and mammography, four were diagnosed with ultrasound alone, and three were diagnosed with mammography alone.

Mammography revealed 18 tumors in the 20 women who had mammograms (90%). Ultrasound detected all 21 tumors in the 20 women who had ultrasound exams (100%).

Additionally, ultrasound correctly imaged the spread of cancer to the lymph nodes in 15 of 18 women (83%) who underwent nodal assessment.

Twelve patients underwent ultrasound evaluation of their response to chemotherapy at about five months post treatment, and ultrasound accurately identified complete response in two patients, partial response in three, stable findings in one, and disease progression in the other six.

"Our findings confirm the useful role of sonography in the evaluation of the breast in pregnant women," the authors said. "In the case of a palpable abnormality, sonography depicts whether the palpable area corresponds to a mass or to normal breast tissue."

In addition, sonography allows for characterization of the abnormality in order to evaluate the need for biopsy, according to previously published criteria, they added.

"The two women in whom no abnormality was visible at mammography, but in whom ultrasound revealed suspicious masses subsequently shown to be cancer with biopsy results, re-emphasize the complementary role of mammography and ultrasound in the diagnosis of breast cancer in the pregnant patient," the authors said.

Most authorities believe that with proper abdominal shielding, mammography poses little risk of radiation exposure to the fetus, because the dose to the fetus is believed to be less than 100 mrad, the authors said.

"We want young women to know that symptomatic breast cancer that occurs during pregnancy can be imaged, diagnosed, and treated while pregnant, so they should not wait to seek medical attention if they start to have suspicious symptoms," Dr. Yang said.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco

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